Skip to main content
SpringerLink
Log in

Akute Pankreatitis im Kindesalter

Epidemiologische Untersuchungsergebnisse einer 10-Jahres-Analyse und Berichte aus der Literatur

Acute pancreatitis in paediatric patients

Results of an epidemiological study conducted as a 10-year analysis and reports in the literature

  • Originalien
  • Published:
Monatsschrift Kinderheilkunde Aims and scope Submit manuscript

Zusammenfassung

Die akute Pankreatitis im Kindesalter ist weit häufiger als bisher angenommen. Die häufigsten Ursachen sind Traumen, Infektionen, Systemerkrankungen und strukturelle Gallenwegläsionen; ein Teil ist idiopathisch. Im Kindesalter verläuft die Pankreatitis überwiegend mild mit guter Prognose. Dennoch sollten die Patienten immer stationär behandelt werden. Zur Unterscheidung einer milden (ödematösen) von einer schweren (hämorrhagisch-nekrotisierenden) Verlaufsform eignen sich am besten die kontrastmittelverstärkte Computertomographie und das C-reaktive Protein. Die Säulen der Therapie sind Schmerzbehandlung, ausreichende Flüssigkeits- und Kalorienzufuhr sowie prophylaktische Antibiose bei Verdacht auf pankreatische Parenchymnekrosen. Die wichtigste Sofortmaßnahme ist eine suffiziente Flüssigkeitszufuhr, um dem drohenden oder manifesten Schock zu begegnen. Die orale, hyperkalorische Ernährung sollte sobald als möglich begonnen werden, ggf. als enterale Ernährung via gastraler oder jejunaler Sonde. In einer eigenen 10-Jahres-Analyse (1991–2000) von 156 Fällen mit akuter Pankreatitis war die traumatisch verursachte Pankreatitis mit 68% die häufigste Form.

Abstract

Acute pancreatitis in childhood is more common than hitherto suspected. The most frequent causes are trauma, infection, systemic diseases and biliary tract lesions; some cases are idiopathic. In nearly all childhood cases the course is mild and there is a good prognosis. Nevertheless, admission to hospital, and in severe cases to an intensive care unit, is recommended. Performance of a contrast-enhanced CT plus determination of the C-reactive protein level is the best way to discriminate between mild (oedematous) and severe (haemorrhagic–necrotising) pancreatitis. Therapeutic tools are pain therapy and an adequate supply of balanced electrolyte solution to counter threatening or actual shock; in addition, oral hypercaloric nutrition should be started as soon as possible, if appropriate as enteral feeding via a gastric or jejunal sound. Antibiotic prophylaxis should also be given when there is any suspicion of necrotising pancreatitis. In a 10-year analysis (1991–2000) of 156 acute pancreatitis cases a traumatic causation was most frequent, accounting for 68% of them.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Assmus C, Petersen M, Gottewleben F et al. (1996) Epidemiology of acute pancreatitis in a defined German population. Digestion 57:217

    Google Scholar 

  2. Benifla M, Weizman Z (2003) Acute pankreatitis in childhood. Analysis of literature data. J Clin Gastroenterol 37:169–172

    Article  Google Scholar 

  3. Berney T, Belli D, Bugmann P et al. (1996) Influence of severe underlying pathology and hypovolemic shock on the development of acute pancreatitis in children. J Pediatr Surg 31:1256–1261

    Article  Google Scholar 

  4. Bokemeyer B (2002) Asymptomatic elevation of serum lipase and amylase in conjunction with Crohn’s disease and ulcerative colitis. Z Gastroenterol 40:5–10

    Article  Google Scholar 

  5. Bradley EL (1993) A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, 11–13 September 1992, Atlanta, GA. Arch Surg 128:586–590

    Google Scholar 

  6. Buntain W, Wood J, Woolley M (1978) Pancreatitis in childhood. J Pediatr Surg 13:143–149

    Google Scholar 

  7. Domínguez-Munoz JE (1999) Diagnosis of acute pancreatitis: any news or still amylase? In: Büchler M, Uhl E, Friess H et al. (eds) Acute pancreatitis: novel concepts in biology and therapy. Blackwell, London, pp 171–180

  8. Eatock FC, Brombacher GD, Steven M et al. (2000) Nasogastric feeding in severe acute pancreatitis may be practical and safe. Int J Pancreatol 28:23–31

    Google Scholar 

  9. Eichelberger M, Hoelzer D, Koop C (1982) Acute pancreatitis: the difficulties of diagnosis and therapy. J Pediatr Surg 17:244–254

    Google Scholar 

  10. Frank B, Gottlieb MD (1999) Amylase normal, lipase elevated: is it pancreatitis? Am J Gastroenterol 94:463–469

    Google Scholar 

  11. Frey C, Redo SF (1963) Inflammatory lesions of the pancreas in infancy and childhood. Pediatrics 32:93–102

    Google Scholar 

  12. Fonkalsrud E, Henney R, Riemenschneider T et al. (1968) Management of pancreatitis in infants and children. Am J Surg 116:198–203

    Article  Google Scholar 

  13. Go VLW (1994) Etiology and epidemiology of pancreatitis in the United States. In: Bradley EL (ed) Acute pancreatitis: diagnosis and therapy. Raven Press, New York, pp 235–239

  14. Haddock G, Coupar G, Youngson G et al. (1994) Acute pancreatitis in children: a 15-year-review. J Pediatr Surg 29:719–722

    Article  Google Scholar 

  15. Hendren W, Greep J, Patton A (1965) Pancreatitis in childhood: experience with 15 cases. Arch Dis Child 40:132–145

    Google Scholar 

  16. Jordan S, Ament M (1977) Pancreatitis in children and adolescents. Pediatrics 91:211–216

    Google Scholar 

  17. Layer P, Rünzi M, Goebell H et al. (2001) Therapie der akuten Pankreatitis. Dtsch Ärztebl 98:B2661–B2663

    Google Scholar 

  18. Leichtner AM, Banta JV, Etienne N et al. (1991) Pancreatitis following scoliosis surgery in children and young adults. J Pediatr Orthop 11:594–598

    Google Scholar 

  19. Moossa A (1972) Acute pancreatitis in childhood. Prog Pediatr Surg 4:111–127

    Google Scholar 

  20. Rünzi M, Layer P, Büchler MW et al. (2000) Therapie der akuten Pankreatitis. Gemeinsame Leitlinien. Z Gastroenterol 38:571–581

    Article  Google Scholar 

  21. Synn A, Mulvihill S, Fonkalsrud E (1987) Surgical management of pancreatitis in childhood. J Pediatr Surg 22:628–632

    Google Scholar 

  22. Tam P, Saing H, Irving I et al. (1985) Acute pancreatitis in children. J Pediatr Surg 20:58–60

    Google Scholar 

  23. Thomas L (2000) Labor und Diagnose, 5. erweiterte Aufl. TH-Books, Marburg

  24. Tomomasa T, Tabata M, Miyashita M et al. (1994) Acute pancreatitis in Japanese and Western children: etiologic comparison. J Pediatr Gastroenterol Nutr 19:109–110

    Google Scholar 

  25. Toouli J, Brooke-Smith M, Bassi C et al. (2002) Guidelines for the management of acute pancreatitis. J Gastroenterol Hepatol 17(Suppl):15–39

    Article  Google Scholar 

  26. Trapnell JE, Duncan EH (1975) Patterns of incidence in acute pancreatitis. Br Med J 2:179–183

    Google Scholar 

  27. Vane D, Grosfeld J, West K et al. (1989) Pancreatic disorders in infancy and childhood: experience with 92 cases. J Pediatr Surg 24:771–776

    Google Scholar 

  28. Van Camp J, Polley T, Coran A (1994) Pancreatitis in children: diagnosis and etiology in 57 patients. Pediatr Surg Int 9:492–497

    Google Scholar 

  29. Vesentini S, Bassi C, Talamini G et al. (1993) Prospective comparison of C-reactive protein level, Ranson score and contrast-enhanced tomography in the prediction of septic complications of acute pancreatitis. Br J Surg 80:755–757

    CAS  PubMed  Google Scholar 

  30. Weizman Z, Durie P (1988) Acute pancreatitis in childhood. Pediatrics 113:24–29

    Google Scholar 

  31. Werlin SL, Kugathasan S, Frautschy BC (2003) Pancreatitis in children. J Pediatr Gastroenterol Nutr 37:591–595

    Google Scholar 

  32. Yeung CY, Lee HC, Huang FY et al. (1996) Pancreatitis in children—experience with 43 cases. Eur J Pediatr 155:458–463

    Google Scholar 

  33. Ziegler D, Long J, Philippart A et al. (1988) Pancreatitis in childhood. Experience with 49 patients. Ann Surg 207:257–261

    Google Scholar 

  34. American Gastroenterological Association (2001) Parenteral nutrition. Gastroenterology 121:966–969

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Dresden

    J. Henker, A. Kaubisch & M. W. Laaß

  2. Klinik und Poliklinik für Kinder- und Jugendmedizin, Universitätsklinikum Carl Gustav Carus, Fetscherstraße 74, 01307, Dresden

    J. Henker

Authors
  1. J. Henker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Kaubisch
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. W. Laaß
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J. Henker.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Henker, J., Kaubisch, A. & Laaß, M.W. Akute Pankreatitis im Kindesalter . Monatsschr Kinderheilkd 154, 245–250 (2006). https://doi.org/10.1007/s00112-004-1061-6

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00112-004-1061-6

Schlüsselwörter

Keywords

Search

Navigation